How long are burn patients really NPO in the perioperative period and can we effectively correct the caloric deficit using an enteral feeding “Catch-up” protocol?

Safety and Tolerance of Intraoperative Enteral Nutrition Support in Pediatric Burn Patients

“…The shortfalls of EN delivery in burn patients have been well documented in the literature. Pham found that adult burn patients had their EN held for up to 14 hours for each surgical procedure, resulting in a deficit of up to 50% of daily calories . Sudenis et al also looked at the EN delivery in adult burn patients and found that a median caloric deficit of 172–930 kcal/d existed because of disruptions in nutrition for surgery, dressing changes, bedside procedures, and feeding intolerances, etc.…”

“…[20][21][22][23][24][25][26][27][28] Initiating early EN is beneficial to meet nutrition needs and protect the structural and functional integrity of the GI tract; however, frequent interruptions in the delivery of nutrition support can lead to significant energy and protein deficits. 4,[10][11][12][13] Meeting the hypermetabolic requirements of a burn patient throughout their clinical course can be very challenging because of the number of recurrent surgical procedures for wound debridement, closure, and reconstruction, resulting in extended periods of time without adequate nutrition. The shortfalls of EN delivery in burn patients have been well documented in the literature.…”

“…Delays in the reinitiation of EN in the postoperative period often occur because of concern for gastric ileus and can negatively impact feeding tolerance and energy and protein delivery. 8,11,33 Shields et al found in their study of enterally fed adult burn patients who were grouped in either a goal rate reinitiation group or a slow reinitiation group after their first surgical procedure that there was no difference in feeding intolerances such as emesis, aspiration, or ischemic bowel. The group whose EN rate was resumed at goal rate postoperatively met a significantly higher amount of caloric goals vs the slow reinitiation group during the 36 hours postsurgery, indicating that a more aggressive approach to feeding preoperatively enhances nutrition intake and is well tolerated.…”

“…Burn patients require multiple surgical procedures for wound debridement, coverage, and reconstruction throughout their clinical course. EN support can be held for 8–14 hours throughout each perioperative period, ultimately resulting in significant caloric and protein deficits . Failure to meet their increased nutrient requirements can lead to poor wound healing, immune dysfunction, and increased infection and mortality rates .…”

“…EN support can be held for 8-14 hours throughout each perioperative period, ultimately resulting in significant caloric and protein deficits. 10,11 Failure to meet their increased nutrient requirements can lead to poor wound healing, immune dysfunction, and increased infection and mortality rates. 12,13 A recent international multicenter study of adult burn patients found that 57% of the 90 patients receiving EN experienced interruptions in delivery, primarily because of surgical procedures.…”